Back pain and neck pain – problems so prevalent that it seems everyone has experienced one or both at least one time in their life. Is there any way to avoid them? Once they start, are you doomed to have pain forever? Much of the answer is up to you.
Research suggests that many spine problems are preventable because they result from poor posture and body mechanics, which subject the spine to abnormal stresses. Abnormal stress over time can lead to structural changes in the spine, including degeneration of disks and joints, lengthening or shortening of the supportive ligaments and muscles, and wear and tear of cartilage. All of these structural changes can lead to pain.
However, there are many things that you can do each day to minimize current spine pain and prevent future episodes from occurring. (Think of your body, especially the spine, as a machine that needs regular care and maintenance to keep it functioning properly and efficiently. For example, does your car work properly when the alignment is off? )
The key factors to taking care of your back and neck center around three concepts:
- Learning and practicing good posture
- Using good body mechanics during the day
- Regular exercise
The foundation for good neck and back care starts with posture. Bad posture can be the cause of spinal pain, it can make existing pain worse, and it certainly can make the pain last a lot longer. Poor posture is also a factor in conditions such as chronic headaches, TMJ dysfunction and shoulder pain. Many people spend large portions of their day sitting or performing tasks that require bending forward or lifting. Think about your lifestyle, the postures you assume, and the activities you perform each day. The basis for good posture is maintaining a “neutral spine.” A neutral spine retains three natural curves: a small hollow at the base of the neck, a small roundness at the middle back, and a small hollow in the low back. A neutral spine is neither rounded forward nor arched back too much. Maintaining a neutral spine is a dynamic process as you transition from one position to another. Let’s look in detail at proper alignment in standing, from the bottom up: (Figure 1)
- Feet should be shoulder width apart, thigh muscles elongated without locking the knees back.
- Maintain a small hollow in your low back, but avoid the tendency for too much arch/leaning back, especially with prolonged standing. The “tail” should remain slightly tucked down.
- Lift the breastbone. As you do this, the shoulder blades will move down in back. This should create a good distance from your hipbone to your rib cage.
- Make your chin level. The highest point of your body should be the top back region of your head. Relax your jaw and neck muscles. With the mouth closed, rest your tongue on the roof or your mouth.
A “wall test” can be performed to help practice good standing posture. Stand with head, shoulders, and back against wall and heels about 5-6 inches forward. Draw in the lower abdominals, decreasing the arch in your low back. Push away from the wall and try to maintain this upright, vertical alignment. Next, let’s examine proper sitting alignment, from the bottom’up: (Figure 2)
- Feet should be resting on the floor with knees and hips bent 90 degrees
- Maintain an arch in the low back. If you are unsure how much arch is “good,” go from a slouched position up to the extreme end range of erect posture. Now back off 10-15%. This is the neutral position for your low back. A “lumbar roll” is recommended to support the low back with prolonged sitting. It is a foam roll, approximately 4-5 inches in diameter, 12 inches long. To place it, scoot your hips back so that you are touching the back of the chair. “Bow” forward and place the roll in the natural arch of your low back.
- Lift your breastbone. Picture a string tied to the 2nd or 3rd top button on a shirt pulling straight up to the ceiling. This again creates a good distance from your ribcage to your hipbones. Your shoulder blades should be down in back. Think of the bottom tips of your shoulder blades as “anchors,” helping you to maintain this upright posture.
- Make your chin level. If it helps, picture a book on your head. The highest point of your body should be the top back region of your head.
- While it is okay to assume other positions for short periods of time, most of your sitting time should be spent as described to allow for the least stress on your spine. It is also strongly recommended to take frequent breaks from sitting and change your position, at least hourly if you have spine problems.
Good posture driving tips are as follows:
- Adjust the seat so that the back is vertical. Allow your back to be supported by the seat back and your head to rest against the headrest with your chin level.
- Knees should be bent to reach the pedals and they should be at the same height or higher than your hips.
- With hands on wheel, elbows should be slightly bent and relaxed.
- Avoid shoulder shrugging.
Finally, let’s look at some good postural tips for sleeping.
- In lying, the spine will be most comfortable when a neutral spine is maintained. A sagging mattress or the use of more than one pillow will interfere with the neutral spine position. A firm mattress is recommended-a board placed between the mattress and box spring can provide a temporary fix to a sagging mattress.
- The best sleeping positions for someone with neck or back pain is either lying on the side or on the back. -When lying on the side, a pillow between the knees helps keep the spine neutral. People who lie on their side without a pillow between the knees sometimes draw one knee up high and in front. This asymmetry can result in pain over time.
- Whether lying on the back or sides, rolls can be added to support the natural curves of the spine in the neck or low back. A “cervical roll” can be used to support the neck. It is a foam roll, approximately 3 inches in diameter and 18 inches long that is placed inside the pillowcase along the lower border of a (preferably down or synthetic down) pillow. The roll is situated between the base of the head and the shoulders, supporting the curve of the neck and helping to maintain neutral alignment lying on the back or in side lying.
A lumbar sleeping roll can be purchased or fashioned for a trial at home. It is a long thin roll tied around the waist to help support the lumbar arch lying on the back or in side lying. The diameter is smaller than the sitting roll, approximately 3-4 inches. To make one at home for a trial:
- Roll a large bath towel lengthwise.
- Stuff the towel roll into one leg of an old pair of pantyhose or feed a rope through the center of the towel roll, securing the roll with masking tape.
- Tie the roll around your waist at the level of the small arch in your low back.
This roll may provide comfort by keeping your back from sagging off center to the right, for example, if you are lying on your right side. If lying on your back, it will help keep your from rounding out your low back.
In short, the key to good posture is awareness and perseverance. It is not easy to change poor postural habits, nor do the changes come quickly. However, if good posture is practiced, it becomes easier and you will find yourself preferring the “neutral alignment” to your previously poor position. In addition to feeling better, good posture also makes you look better. It is said that good posture can make you look 10 pounds lighter and 10 years younger! Give it a try. The benefits are well worth the effort.